Oral hydration compared to intravenous hydration in the prevention of post-contrast acute kidney injury in patients with chronic kidney disease stage IIIb: A phase III non-inferiority study (NICIR study)

Abstract Background The objective of this study is to evaluate oral hydration compared to intravenous (i.v.) hydration in the prevention of post-contrast acute kidney injury (PC-AKI) in the oncologic subgroup of patients with stage IIIb chronic kidney disease (CKD) included in the NICIR study referred for elective contrast-enhanced computed tomography (CE-CT). Material and Methods We performed a retrospective subanalysis of the oncological subgroup (174/228 patients, 74%) from a continuous prospective database of patients included in the recently published non-inferiority NICIR study. Patients received prophylaxis against PC-AKI with either oral hydration (500 mL of water two hours before and 2000 mL during the 24 hours after CE-CT) or i.v. hydration (sodium bicarbonate (166 mmol/L)3 mL/kg/h starting one hour before and 1 mL/kg/h during the first hour after CE-CT). The primary outcome was to compare the proportion of PC-AKI in the first 48 to 72 hours after CE-CT in the two hydration groups. Secondary outcomes were to compare persistent PC-AKI, the need for hemodialysis, and the occurrence of adverse events related to prophylaxis in each group. Results Of 174 patients included in the subanalysis, 82 received oral hydration and 92 received i.v. hydration. There were no significant differences in clinical characteristics or risk factors between the two study arms. Overall the PC-AKI rate was 4.6% (8/174 patients), being 3.7% in the oral hydration arm (3/82 patients) and 5.4% (5/92 patients) in the i.v. hydration arm. The persistent PC-AKI rate was 1.8% (1/82 patients) in the oral hydration arm and 3.3% (3/92 patients) in the i.v. hydration arm. No patient required dialysis during the first month after CE-CT or had adverse effects related to the hydration regime. Conclusion In oncological patients with stage IIIb CKD referred for elective CE-CT, the rate of PC-AKI in those receiving oral hydration did not significantly differ from that of patients receiving i.v. hydration.

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Atrial Fibrillation and Chronic Kidney Disease—A Risky Combination for Post-Contrast Acute Kidney Injury

Journal of Clinical Medicine ◽

10.3390/jcm10184140 ◽

2021 ◽

Vol 10 (18) ◽

pp. 4140

Author(s):

Łukasz Kuźma ◽

Anna Tomaszuk-Kazberuk ◽

Anna Kurasz ◽

Małgorzata Zalewska-Adamiec ◽

Hanna Bachórzewska-Gajewska ◽

...

Keyword(s):

Atrial Fibrillation ◽

Chronic Kidney Disease ◽

Acute Kidney Injury ◽

Kidney Disease ◽

Coronary Angiography ◽

Kidney Injury ◽

Post Contrast ◽

Acute Kidney Disease ◽

Patients At Risk ◽

Kidney Impairment

Atrial fibrillation (AF) symptoms may mimic coronary artery disease (CAD) which reflects the difficulties in qualifying AF patients for invasive diagnostics. A substantial number of coronary angiographies may be unnecessary or even put patients at risk of post-contrast acute kidney injury (PC-AKI), especially patients with chronic kidney disease (CKD). We aimed to investigate the hypothesis indicating higher prevalence of PC-AKI in patients with AF scheduled for coronary angiography. The study population comprised of 8026 patients referred for elective coronarography including 1621 with AF. In the comparison of prevalence of PC-AKI in distinguished groups we can see that kidney impairment was twice more frequent in patients with AF in both groups with CKD (CKD (+)/AF (+) 6.24% vs. CKD (+)/AF (−) 3.04%) and without CKD (CKD (−)/AF (+) 2.32% vs. CKD (−)/AF (−) 1.22%). In our study, post-contrast acute kidney disease is twice more frequent in patients with AF, especially in subgroup with chronic kidney disease scheduled for coronary angiography. Additionally, having in mind results of previous studies stating that AF is associated with non-obstructive coronary lesions on angiography, patients with AF and CKD may be unnecessarily exposed to contrast agent and possible complications.

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Incidence, Predictors, and Prognosis of Acute Kidney Injury Among Cardiac Arrest Survivors

Journal of Intensive Care Medicine ◽

10.1177/0885066620911353 ◽

2020 ◽

pp. 088506662091135

Author(s):

Abhishek Dutta ◽

Krupal J. Hari ◽

John Azizian ◽

Youssef Masmoudi ◽

Fatima Khalid ◽

...

Keyword(s):

Acute Kidney Injury ◽

Cardiac Arrest ◽

Kidney Disease ◽

Chronic Kidney Disease Stage ◽

Kidney Injury ◽

Disease Stage ◽

Neurological Outcomes ◽

Risk Of Mortality ◽

Increased Risk ◽

Acute Kidney Injury Stage

Background: Acute kidney injury (AKI) is common among cardiac arrest survivors. However, the outcomes and predictors are not well studied. Methods: This is a cohort study of cardiac arrest patients enrolled from January 2012 to December 2016 who were able to survive for 24 hours post-cardiopulmonary resuscitation. Patients with anuria, chronic kidney disease (stage 5), and end-stage renal disease were excluded. Acute kidney injury (stage 1) or higher was defined using Kidney Disease: Improving Global Outcomes classification. Multivariable adjusted regression models were used to compute hazard ratio (HR) for association of AKI with risk of mortality and odds ratio (OR) with risk of poor neurological outcomes after adjusting for demographics, comorbidities, and medical therapy. Multivariable logistic regression model was used to compute OR for association of various predictors with AKI. Results: Of 842 cardiac arrest survivors, 588 (69.8%) developed AKI. Among AKI patients, 69.4% died compared with 52.0% among non-AKI patients. In multivariable adjusted Cox proportional hazard model, development of AKI post-cardiac arrest was significantly associated with mortality (HR: 1.35; 95% confidence interval [CI]: 1.07-1.71, P = .01) and poor neurological outcomes defined as cerebral performance category >2 (OR: 2.27; 95% CI: 1.45-3.57, P < .001) and modified Rankin scale >3 (OR: 2.22; 95% CI: 1.43-3.45, P < .001). Postdischarge dialysis was also associated with increased risk of mortality (HR: 2.57; 95% CI: 1.57-4.23, P < .001). Use of vasopressors was strongly associated with development of AKI and continued need for postdischarge dialysis. Conclusions: Acute kidney injury was associated with increased risk of mortality and poor neurological outcomes. There is need for further studies to prevent AKI in cardiac arrest survivors.

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Intermittent hemodialysis in dogs with chronic kidney disease stage III

Ciência Rural ◽

10.1590/0103-8478cr20160900 ◽

2017 ◽

Vol 47 (10) ◽

Author(s):

Alessandra Melchert ◽

Silvano Salgueiro Geraldes ◽

André Nanny Le Sueur Vieira ◽

Regina Kiomi Takahira ◽

Paulo Roberto Rodrigues Ramos ◽

...

Keyword(s):

Chronic Kidney Disease ◽

Kidney Disease ◽

Chronic Kidney Disease Stage ◽

Kidney Injury ◽

Electrolyte Imbalance ◽

Stage Iii ◽

Disease Stage ◽

Control Group ◽

Intermittent Hemodialysis ◽

Before And After

ABSTRACT: Intermittent hemodialysis (IHD) is a form of renal replacement that is used in veterinary medicine for cases involving drug removal, electrolyte imbalance, acute kidney injury, and chronic kidney disease (CKD). The aim of the present study was to verify the efficacy of IHD in dogs with CKD staged at grade III and to evaluate the effect of IHD on quality of life. Twelve dogs with CKD at stage III met the inclusion criteria and were divided equally into two groups. The control group (n=6) received only clinical treatment and intravenous fluid therapy, and the hemodialysis group (n=6) received clinical and IHD treatments. Blood samples were collected before and after treatments in both groups. We evaluated complications and clinical parameters of IHD every 30 minutes. Hemodialysis decreased serum urea, creatinine, and phosphorus. Despite the evident removal of nitrogen compounds, dialysis treatment did not increase survival time in these patients. The results of this study do not support the early use of dialysis in dogs with chronic kidney disease stage III.

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Post-Contrast Acute Kidney Injury in Patients with Various Stages of Chronic Kidney Disease—Is Fear Justified?

Toxins ◽

10.3390/toxins13060395 ◽

2021 ◽

Vol 13 (6) ◽

pp. 395

Author(s):

Inga Chomicka ◽

Marlena Kwiatkowska ◽

Alicja Lesniak ◽

Jolanta Malyszko

Keyword(s):

Computed Tomography ◽

Chronic Kidney Disease ◽

Acute Kidney Injury ◽

Kidney Disease ◽

Kidney Injury ◽

Creatinine Concentration ◽

Post Contrast ◽

Iodinated Contrast ◽

Contrast Enhanced Ct ◽

Enhanced Ct

Post-contrast acute kidney injury (PC-AKI) is one of the side effects of iodinated contrast media, including those used in computed tomography. Its incidence seems exaggerated, and thus we decided to try estimate that number and investigate its significance in our clinical practice. We analyzed all computed tomographies performed in our clinic in 2019, including data about the patient and the procedure. In each case, we recorded the parameters of kidney function (serum creatinine concentration and eGFR) in four time intervals: before the test, immediately after the test, 14–28 days after the test, and over 28 days after the test. Patients who did not have a follow-up after computed tomography were excluded. After reviewing 706 CT scans performed in 2019, we included 284 patients undergoing contrast-enhanced CT and 67 non-enhanced CT in the final analysis. On this basis, we created two comparable groups in terms of age, gender, the severity of chronic kidney disease, and the number of comorbidities. We found that AKI was more common in the non-enhanced CT population (25.4% vs. 17.9%). In terms of our experience, it seems that PC-AKI is not a great risk for patients, even those with chronic kidney disease. Consequently, the fear of using contrast agents is not justified.

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Contrast-induced acute kidney injury

Oxford Textbook of Interventional Cardiology ◽

10.1093/med/9780198754152.003.0029 ◽

2018 ◽

pp. 447-452

Author(s):

Peter A. McCullough

Keyword(s):

Acute Kidney Injury ◽

Kidney Disease ◽

Chronic Kidney Disease Stage ◽

Kidney Injury ◽

Disease Stage ◽

Glomerular Function ◽

Catheterization Laboratory ◽

Sustained Reduction ◽

Contrast Exposure ◽

Definition Of

Contrast-induced acute kidney injury, previously known as contrast-induced nephropathy, is an important complication in the catheterization laboratory. The definition of contrast-induced acute kidney injury should be harmonized with the Kidney Disease International Global Outcomes criteria which calls for >=0.3 mg/dl (26.5 micromol/L) rise in serum creatinine within 48 hours of contrast exposure. If there is a sustained reduction in estimated glomerular function from a baseline above 60 to a new baseline below 60 ml/min/1.73 m2 at 90 days after the procedure, then a definition of chronic kidney disease (Stage 3) would be met as a late outcome of this complication.

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Intravenous Hydration (With or Without Rosuvastatin) Should Remain the Cornerstone of the Prevention of Contrast-Induced Acute Kidney Injury in Patients With Diabetes and Chronic Kidney Disease

Journal of the American College of Cardiology ◽

10.1016/j.jacc.2014.02.614 ◽

2014 ◽

Vol 64 (3) ◽

pp. 332 ◽

Cited By ~ 4

Author(s):

Nicolas Cecere ◽

Michel Jadoul ◽

Laura Labriola

Keyword(s):

Chronic Kidney Disease ◽

Acute Kidney Injury ◽

Kidney Disease ◽

Kidney Injury ◽

Patients With Diabetes ◽

Intravenous Hydration

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Knowledge Does Not Correspond to Adherence of Renal Diet Restrictions in Patients With Chronic Kidney Disease Stage 3-5

Journal of Renal Nutrition ◽

10.1053/j.jrn.2020.08.007 ◽

2020 ◽

Author(s):

Melanie Betz ◽

Althera Steenes ◽

Lauren Peterson ◽

Milda Saunders

Keyword(s):

Chronic Kidney Disease ◽

Kidney Disease ◽

Chronic Kidney Disease Stage ◽

Disease Stage ◽

Renal Diet

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Phosphate binders in patients with chronic kidney disease: Between the new and the old.

10.32512/jmr.2.1.2019/2.3 ◽

2019 ◽

pp. 2-3

Keyword(s):

Chronic Kidney Disease ◽

Kidney Disease ◽

Estimated Glomerular Filtration Rate ◽

Chronic Kidney Disease Stage ◽

Disease Stage ◽

Phosphate Binders ◽

Advanced Chronic Kidney Disease ◽

Phosphate Retention ◽

Stage 4 ◽

Dietary Phosphate

Impaired phosphate excretion by the kidney leads to Hyperphosphatemia. It is an independent predictor of cardiovascular disease and mortality in patients with advanced chronic kidney disease (stage 4 and 5) particularly in case of dialysis. Phosphate retention develops early in chronic kidney disease (CKD) due to the reduction in the filtered phosphate load. Overt hyperphosphatemia develops when the estimated glomerular filtration rate (eGFR) falls below 25 to 40 mL/min/1.73 m2. Hyperphosphatemia is typically managed with oral phosphate binders in conjunction with dietary phosphate restriction. These drugs aim to decrease serum phosphate by binding ingested phosphorus in the gastrointestinal tract and its transformation to non-absorbable complexes [1].

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